Extragenital Gonorrhea Research Articles

In vitro susceptibility of Neisseria gonorrhoeae to netilmicin and etimicin in comparison to gentamicin and other aminoglycosides

PurposeSingle doses of gentamicin have demonstrated clinical efficacy in the treatment of urogenital gonorrhea, but lower cure rates for oropharyngeal and anorectal gonorrhea. Formulations selectively enriched in specific gentamicin C congeners have been proposed as a less toxic alternative to gentamicin, potentially permitting higher dosing to result in increased plasma exposures at the extragenital sites of infection. The purpose of the present study was to compare the antibacterial activity of individual gentamicin C congeners against Neisseria gonorrhoeae to that of other aminoglycoside antibiotics.MethodsAntimicrobial susceptibility of three N. gonorrhoeae reference strains and 152 clinical isolates was assessed using standard disk diffusion, agar dilution, and epsilometer tests.ResultsGentamicin C1, C2, C1a, and C2a demonstrated similar activity against N. gonorrhoeae. Interestingly, susceptibility to the 1-N-ethylated aminoglycosides etimicin and netilmicin was significantly higher than the susceptibility to their parent compounds gentamicin C1a and sisomicin, and to any other of the 25 aminoglycosides assessed in this study. Propylamycin, a 4’-propylated paromomycin analogue, was significantly more active against N. gonorrhoeae than its parent compound, too.ConclusionSelectively enriched gentamicin formulations hold promise for a less toxic but equally efficacious alternative to gentamicin. Our study warrants additional consideration of the clinically established netilmicin and etimicin for treatment of genital and perhaps extragenital gonorrhea. Additional studies are required to elucidate the mechanism behind the advantage of alkylated aminoglycosides.

Extragenital Sexually Transmitted Infections Testing During COVID-19 Pandemic Among Youth Involved in the Juvenile Justice System.

Studies have shown lower screening for sexually transmitted infections (STIs) during the COVID-19 pandemic. It is unclear how the pandemic affected STI testing among juvenile justice-involved youth, especially for extragenital gonorrhea and chlamydia. Retrospective chart review was conducted between March 2020 and June 2021 utilizing electronic health records of youth seen at a preadjudication facility in the southwest United States. Rates of extragenital testing were compared with prepandemic rates. Overall, 574 youth were observed; 86% were male, mean age was 15.4 years, and 48.6% were Black. Of the youth reporting performing oral sex, 57% were tested for oropharyngeal STIs compared to 33.5% in 2018 to 2019. Twenty percent of those reporting anal receptive sex were tested for rectal infections compared to 25.9% before the pandemic. Pandemic testing for oropharyngeal STIs increased but rectal testing decreased. Overall, testing rates remained low.

Improving provider-initiated testing for HIV and other STI in the primary care setting in Amsterdam, the Netherlands: Results from a multifaceted, educational intervention programme.

In the Netherlands, general practitioners (GPs) play a key role in HIV testing. However, the proportion of people diagnosed with late-stage HIV remains high, and opportunities for earlier diagnosis are being missed. We implemented an educational intervention to improve HIV and STI testing in primary care in Amsterdam, the Netherlands. GPs were invited to participate in an educational program between 2015 and 2020, which included repeat sessions using audit and feedback and quality improvement plans. Data on HIV, chlamydia and gonorrhoea testing by GPs were collected from 2011 through 2020. The primary outcome was HIV testing frequency, which was compared between GPs before and after participation using Poisson regression. Secondary outcomes were chlamydia and gonorrhoea testing frequencies, and positive test proportions. Additional analyses stratified by patient sex and age were done. GPs after participation performed 7% more HIV tests compared to GPs before participation (adjusted relative ratio [aRR] 1.07, 95%CI 1.04-1.09); there was no change in the proportion HIV positive tests (aRR 0.87, 95%CI 0.63-1.19). HIV testing increased most among patients who were female and ≤19 or 50-64 years old. After participation, HIV testing continued to increase (aRR 1.02 per quarter, 95%CI 1.01-1.02). Chlamydia testing by GPs after participation increased by 6% (aRR 1.06, 95%CI 1.05-1.08), while gonorrhoea testing decreased by 2% (aRR 0.98, 95%CI 0.97-0.99). We observed increases specifically in extragenital chlamydia and gonorrhoea testing. The intervention was associated with a modest increase in HIV testing among GPs after participation, while the proportion positive HIV tests remained stable. Our results suggest that the intervention yielded a sustained effect.

Availability of Extragenital Chlamydia and Gonorrhea Testing in 6 High-Incidence States.

Extragenital testing (rectal and oropharyngeal) of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) increases the detection of CT/NG infections, compared with genital testing alone. The Centers for Disease Control and Prevention recommends annual extragenital CT/NG screening for men who have sex with men, and additional screenings for women and transgender or gender-diverse individuals if certain sexual behaviors and exposures are reported. Prospective computer-assisted telephonic interviews were conducted with 873 clinics between June 2022 and September 2022. The computer-assisted telephonic interview followed a semistructured questionnaire that included closed-ended questions on the availability and accessibility of CT/NG testing. Of the 873 clinics, CT/NG testing was offered in 751 clinics (86.0%), and extragenital testing was offered in only 432 clinics (57.5%). Most clinics (74.5%) with extragenital testing do not offer tests unless patients request them and/or report symptoms. Additional barriers to accessing information on available CT/NG testing include clinics not picking up the telephone, disconnecting the call, and unwillingness or inability to answer questions. Despite evidence-based recommendations from the Centers for Disease Control and Prevention, the availability of extragenital CT/NG testing is moderate. Patients seeking extragenital testing may encounter barriers such as fulfilling specific criteria or being unable to access information on testing availability.

Added Value of Extragenital Sexually Transmitted Infection Testing in "IWantTheKit" Program Users.

The 2021 Centers for Disease Control and Prevention sexually transmitted infection treatment guidelines recommend extragenital testing for gonorrhea and chlamydia in men who have sex with men and for women based on reported behaviors and exposures. The "IWantTheKit (IWTK)" program is a free online platform for specimen self-collection and mail-in for combined chlamydia/gonorrhea testing. We sought to assess the additional diagnostic value of extragenital testing compared with genital testing only for chlamydia/gonorrhea and determine factors associated with a positive extragenital test result among IWTK users. From August 2013 to January 2022, 7612 unique IWTK users returned swabs for testing; 3407 (45%) users requested both genital and extragenital tests and were included in this analysis. Descriptive statistics were summarized for demographic characteristics, reported behaviors, and genital and extragenital test results, and data were stratified by gender and age group. A logistic regression model was used to estimate associations between factors and extragenital sexually transmitted infection positivity. Chlamydia positivity rates were 4.7%, 2.4%, and 1.5% at genital, extragenital, and both sites, respectively; for gonorrhea, 0.4%, 1.1%, and 0.4% were positive at those sites, respectively. Among women, age 25 years and younger was significantly associated with extragenital chlamydia (odds ratio [OR], 4.0; P = 0.010). Being in high-risk quiz score group was associated with extragenital chlamydia (OR, 2.6; P = 0.005) and extragenital gonorrhea in men and women (OR, 8.5; P = 0.005). Extragenital testing detected additional chlamydia and gonorrhea cases in the IWTK user population that would have been missed by genital-only testing, especially for women younger than 25 years and people reported to be at high risk.

Automated Sexual History and Self-Collection of Extragenital Chlamydia and Gonorrhea Improve Detection of Bacterial Sexually Transmitted Infections in People with HIV.

With consistently rising rates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) since 2014, the need for increased screening, testing, and treatment of bacterial sexually transmitted infections (STIs) in people at risk is clear. In this study, people with HIV were asked to complete a comprehensive audio computer-assisted self-interview sexual history at routine clinic-based laboratory visits every 3-6 months. The sexual health screening resulted in an automated summary of recommended bacterial STI tests. Self-collection of recommended extragenital CT/GC specimens was implemented to decrease the need for a provider to collect the specimen(s) and to give more control to the client. In total, extragenital CT/GC testing returned a 7.3% (n = 11) test positivity for CT and/or GC, with the highest test positivity of 14% (n = 7) among rectal swabs and 4% (n = 4) for pharyngeal swabs. Urogenital testing for combined CT/GC returned a 4.8% (n = 11) test positivity. All participants with extragenital CT/GC who underwent simultaneous urine testing returned discordant laboratory results, with urine collected at the same clinic visit resulting as negative. In addition, 7 of 11 (63.6%) of the positive extragenital GC/CT cases were asymptomatic. Therefore, extragenital site-specific testing was essential in appropriately diagnosing and treating CT and GC among participants. When extragenital STI testing was recommended, participants needing extragenital CT/GC specimens primarily chose self-collection after a brief demonstration. Error rates between self- versus provider-collected samples did not differ, and participants provided positive feedback on the intervention and self-collection process in satisfaction surveys taken at the end of each visit.

PREVALENCE OF PHARYNGEAL AND RECTAL CHLAMYDIA TRACHOMATIS AND NEISSERIA GONORRHOEAE INFECTIONS AMONG MSM IN SOFIA, BULGARIA

Abstract: Sexually transmitted infections (STIs) caused by Chlamydia trachomatis and Neisseria gonorrhoeae continue to be a major public health problem. Although they mainly affect the urogenital tract, N. gonorrhoeae and C. trachomatis can also be found in the pharynx and rectum. As data on extragenital chlamydia and gonorrhea in Bulgaria are still scarce, this study aimed to (1) determine the prevalence of pharyngeal and rectal infections with C. trachomatis and N. gonorrhoeae among men who have sex with men (MSMs) from Sofia and (2) to identify risk factors related to these infections to support screening recommendations based on scientific evidence. One hundred and fifteen MSM aged 16-50 were tested by systematic sampling during a visit to a sexual health center for voluntary and confidential HIV testing in Sofia. A questionnaire was used to collect demographics and risk factors, and clinical material from three anatomical sites: pharynx, rectum, and urogenital tract (first void urine or urethral swab) was examined to detect C. trachomatis and N. gonorrhoeae infections. The prevalence of C. trachomatis was 8.7% in the rectal samples tested, and the prevalence of N. gonorrhoeae was 0.9% and 5.2% in the pharyngeal and rectal samples, respectively. Local symptoms were reported in only 16.6% of rectal gonococcal infections and in 20% of C. trachomatis rectal infections. Patients reporting multiple partners had a significantly higher risk of being positive (OR = 3.8, 95% CI 1.03-14). The risk of HIV-positive MSM and those having unsafe sex was also higher (OR = 1.9 95% CI 0.19-20 and OR = 4.6 95% CI 0.98-21, respectively), but the findings were not statistically significant. Overall, more than 80% of extragenital infections would remain undetected and therefore transmissible if only symptomatic cases were investigated. These results suggest that in Bulgaria HIV-positive MSM and those having multiple sexual partners and unprotected sex would benefit from screening for extragenital STIs. Larger sample surveys could provide a better characterization of risk factors to guide screening choices.

Healthcare provider awareness of the recent FDA approval on first diagnostic tests for extragenital testing for chlamydia and gonorrhea

To assess healthcare provider awareness of the Food and Drug Administration (FDA) 2019 approval of nucleic acid amplification tests (NAAT) using extragenital specimens for chlamydia and gonorrhea, several questions were included in fall 2020 Porter Novelli's DocStyles survey, a US nationally representative semi-annual web-based survey of healthcare providers. There were 1502 respondents included in this study, 1000 family practitioners/internists as primary care physicians (PCPs), 251 obstetricians/gynecologists (OBs/GYNs), and 251 nurse practitioners/physician assistants (NP/PA). Awareness of this FDA approval was 34.3% overall and significantly varied by provider specialty: 45.0% for OB/GYN versus 23.5% for NP/PA, p < 0.01. OB/GYN had the lowest rate of ordering any extragenital gonorrhea and chlamydia tests in the past 12 months (31.6%) versus the other providers (ranging from 46.2% for NP/PA to 60.7% for PCP). The respondents were more likely to be aware of the FDA approval if they had ordered extragenital chlamydia or gonorrhea testing for men who have sex with men (MSM) than those who did not order the tests for MSM (72.3% versus 43.7%, p < 0.01). Of 1502 respondents, lack of reimbursement as a barrier to ordering extragenital tests for chlamydia and gonorrhea was most mentioned (16.6%) overall and did not significantly vary by provider's specialty. Further outreach is needed to educate healthcare providers on the changes in the FDA approval for extragenital gonorrhea and chlamydia testing so that they can provide comprehensive care to their patients and to reduce the potential for antimicrobial resistance.

1357. Patterns of Extragenital Gonorrhea and Chlamydia Testing at a Community-Based Academic Emergency Department in Columbus, Ohio

BackgroundSexually transmitted infections (STI), including gonorrhea (GC) and chlamydia (CT), are on the rise in the U.S. and emergency department (ED) visits for STI-related complaints are common. The ED plays a key role in testing for GC/CT. In addition to testing genital sites for GC/CT, the Centers for Disease Control and Prevention (CDC) recommends extragenital testing (oral/rectal) based on sexual history and exposure. In this study, we reviewed the proportion of extragenital GC/CT tests performed at a community-based academic ED in Columbus, Ohio.MethodsThis study was a retrospective chart review of all GC/CT tests performed at the Ohio State University Hospitals East ED from November 1, 2018 to November 1, 2020. Clinical and demographic information was collected for all patients who received extragenital GC/CT testing, including symptoms, test results, and documentation of sexual practices. A random convenience sample of 100 patients who only had genital GC/CT testing performed was also reviewed.ResultsOf the 5644 GC/CT tests performed during the study period, only 364 (6.4%) were from extragenital sites, which included 311 (5.5%) from oral and 53 (< 1%) from rectal sites. Of the 100 patients reviewed who did not have extragenital GC/CT testing performed, only 5 (5%) had documentation of sexual practices, compared with 177/311 (56.9%) of those who had oral testing and 27/31 (50.94%) who had rectal testing performed. In the cohort of 100 patients who did not receive extra genital testing 28% were male and average age was 29. In the group who received extragenital testing 40% were male and average age was 30. The most common complaint across all groups was genital dischargeConclusionDespite the substantial number of CG/CT tests performed in the ED, only a very small proportion were from extragenital sites. Interventions are needed to identify and overcome barriers to extragenital GC/CT testing in the ED.Disclosures Mohammad Mahdee Sobhanie, M.D., Regeneron (Scientific Research Study Investigator)Regeneron (Scientific Research Study Investigator, Was a sub-investigator for Regeneron 2066 and 2069) Carlos Malvestutto, M.D., Lilly (Scientific Research Study Investigator)Regeneron Inc. (Scientific Research Study Investigator)ViiV Healthcare (Advisor or Review Panel member)

Evidence supporting the standardisation of extragenital gonorrhoea and chlamydia screenings for women

ObjectiveCurrent guidelines for women do not include extragenital screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) and do not mention anal sex behaviour. The objective of this cross-sectional study...

Rectal specimen self-collection for chlamydia and gonorrhea screening: a cross-sectional feasibility study at a community health center

BackgroundMen who have sex with men (MSM) are at increased risk for extra-genital sexually transmitted infections (STIs). Without extra-genital screening, many chlamydia and gonorrhea infections would be missed among MSM. Yet, many barriers exist to extra-genital testing, and, in particular, to rectal collection. Self-collection increases screening and detection of asymptomatic chlamydia and gonorrhea among at-risk MSM and transgender women. This feasibility study assessed use of rectal self-collection and its acceptance among patients and primary care providers (PCPs) at a large, general practice community health center. The primary objective of this project was to assess the feasibility of including rectal self-collection as part of an implementation study looking to embed an STI care program in a safety-net primary care setting that would shift routine screening tasks to non-provider clinical team members such as medical assistants and nurses.MethodsThree PCPs identified and offered rectal self-collection to their MSM and transgender female patients who were due for routine or risk-based STI screening. For those patients who elected to participate in the study, the PCP’s medical assistant (MA) reviewed the self-collection instructions with them as part of their routine preventive care duties, and patients collected their own sample. Patients and PCPs completed brief cross-sectional surveys assessing the self-collection process.ResultsOf 1191 patients with sexual orientation and gender identity (SOGI) data on file who were seen for a medical visit by one of the three PCPs, 87 (7.3%) identified as MSM or transgender female. Seventy-five were due for rectal screening, of whom 33 (44%) were offered and completed rectal self-collection. Survey results indicated that self-collection was acceptable to and preferred over clinician-collection by both PCPs and patients.ConclusionsThis study demonstrated that rectal self-collection is feasible as part of STI screening in a high-volume primary care setting, and can be administered as part of the clinical tasks that MAs routinely conduct. The overall acceptance by both PCPs and patients will allow the inclusion of rectal self-collection in an implementation study looking to increase STI screening at a large community health center by facilitating MA-led collection during medical provider visits and by establishing standalone nurse-led STI visits.

Demographic, Behavioral, and Clinical Characteristics of Persons Seeking Care at Sexually Transmitted Disease Clinics - 14 Sites, STD Surveillance Network, United States, 2010-2018.

Demographic, Behavioral, and Clinical Characteristics of Persons Seeking Care at Sexually Transmitted Disease Clinics - 14 Sites, STD Surveillance Network, United States, 2010-2018.

A case of primary extragenital cutaneous gonorrhea involving the finger

A case of primary extragenital cutaneous gonorrhea affecting the left middle finger of a 16-year-old female patient is presented. The patient denied a history of sexual activity and the only reported symptoms were finger pain and associated lymphangitis. Wound culture was obtained from an incision, and drainage procedure was performed at an emergency room of a community hospital. Laboratory diagnosis was made at a clinical microbiology laboratory using Gram stain, agar culture, and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Concurrent blood cultures had no growth at 5 days. The patient was switched from Cephalexin and Trimethoprim-sulfamethoaxole to an appropriate regimen upon sensitivity testing. The patient was lost to follow-up, and it is unknown if the possibility of seeding mucosal infection, such as the pharynx, was investigated.

Efficacy of 1 g Ceftriaxone Monotherapy Compared to Dual Therapy With Azithromycin or Doxycycline for Treating Extragenital Gonorrhea Among Men Who Have Sex With Men.

Evidence on efficacy of high-dose ceftriaxone monotherapy for extragenital Neisseria gonorrhoeae (NG) infection is lacking. A cohort of men who have sex with men (MSM) were tested for NG/Chlamydia trachomatis (CT) every 3 months, in a single-center observational study in Tokyo, Japan. MSM aged > 19 years diagnosed with extragenital NG infection between 2017 and 2020 were included. A single dose of 1 g ceftriaxone monotherapy was provided, while dual therapy with a single oral dose of 1 g azithromycin or 100 mg doxycycline administered orally twice daily for 7 days were given, for those coinfected with CT, according to infected sites. Efficacy of these treatments was calculated by the number of NG-negative subjects at test-of-cure divided by the number of subjects treated. Fisher exact tests were used to compare the efficacy between the 2 groups. Of 320 cases diagnosed with extragenital NG, 208 were treated with monotherapy and 112 were treated with dual therapy. The efficacy against total, pharyngeal, and rectal infections was 98.1% (204/208, 95% confidence interval [CI]: 95.2-99.3%), 97.8% (135/138, 95% CI: 93.8-99.4%), and 98.6% (69/70, 95% CI: 92.3-99.9%), respectively, in the monotherapy group, whereas the corresponding efficacy in the dual therapy was 95.5% (107/112, 95% CI: 90.0-98.1%), 96.1% (49/51, 95% CI: 86.8-99.3%), and 95.1% (58/61, 95% CI: 86.5-98.7%), respectively. No significant difference in the corresponding efficacy was observed between the two groups (P = .29, P = .61, P = .34, respectively). High-dose ceftriaxone monotherapy is as effective as dual therapy for extragenital NG among MSM.

Pre-exposure Prophylaxis Use and Detected Sexually Transmitted Infections Among Men Who Have Sex With Men in the United States-National HIV Behavioral Surveillance, 5 US Cities, 2017.

Men who have sex with men (MSM) using HIV pre-exposure prophylaxis (PrEP) may be at high risk for bacterial sexually transmitted infections (STIs). We examined the prevalence of extragenital gonorrhea and chlamydia by PrEP status among a multisite sample of US MSM. MSM aged ≥18 years were recruited through venue-based sampling to participate in the 2017 National HIV Behavioral Surveillance. In 5 cities (San Francisco, Washington DC, New York City, Miami, and Houston), participants completed a questionnaire, HIV testing, and pharyngeal and rectal STI specimen self-collection. We measured prevalence of pharyngeal and rectal gonorrhea and chlamydia among self-reported non-HIV-positive MSM who reported using or not using PrEP in the previous 12 months. Overall, 29.6% (481/1627) of non-HIV-positive MSM reported PrEP use in the past year. MSM who reported PrEP use were more likely to have any STI (ie, extragenital gonorrhea and/or chlamydia) than MSM not on PrEP [14.6% vs. 12.0%, adjusted prevalence ratio (aPR) = 1.5, 95% confidence interval (CI) : 1.1 to 2.0], reflecting differences in rectal chlamydia prevalence (8.7% vs. 6.0%, aPR = 1.6, 95% CI: 1.1 to 2.4). PrEP use was not associated with pharyngeal chlamydia, pharyngeal gonorrhea, or rectal gonorrhea. The prevalence of extragenital STI was high for both MSM on PrEP and those not on PrEP in the past year. MSM on PrEP were more likely to have rectal chlamydia but not pharyngeal STIs or rectal gonorrhea. Our findings support regular STI testing at exposed anatomic sites as recommended for sexually active MSM, including those on PrEP.

Prevalence of and Factors Associated With Genital and Extragenital Chlamydia and Gonorrhea Among Transgender Women in HIV Care in the United States, 2005 to 2016.

Data on testing rates and prevalence of and factors associated with genital and extragenital chlamydia and gonorrhea among transgender women with HIV in the United States are limited. This retrospective cohort analysis included transgender women living with HIV enrolled in the US Centers for AIDS Research Network of Integrated Clinical Systems cohort between January 2005 and December 2016 with chlamydia or gonorrhea testing performed in HIV clinic. The primary outcome was a positive test result for chlamydia or gonorrhea at urogenital or extragenital (rectal/pharyngeal) sites. Factors associated with infection were examined using logistic regression and generalized estimating equations to account for multiple tests per woman. Among 312 transgender women in HIV care, 252 (81%) were tested for chlamydia or gonorrhea at least once. Annual testing rates were low: 23% to 53% at genital sites and 24% to 47% at extragenital sites. A total of 88 infections were detected, and 22% of women (55/252) had at least one positive test result. Most infections occurred at extragenital sites (80% of chlamydia and 82% of gonorrhea positive test results). Factors associated with infection in an adjusted model were as follows: age 18 to 29 years compared with ≥50 years (adjusted odds ratio [aOR], 7.6; 95% confidence interval [CI], 1.8-31.2), CD4 count >350 compared with CD4 <200 (aOR, 5.5; 95% CI, 1.2-25.1), and higher engagement in HIV care (aOR, 2.2; 95% CI, 1.0-4.5). Among transgender women living with HIV, testing rates for chlamydia and gonorrhea are inadequate, particularly at extragenital sites where most infections occur.

Estimating Recommended Gonorrhea and Chlamydia Treatment Rate Using Linked Medical Claims, Prescription, and Laboratory Data in US Private Settings.

The Centers for Disease Control and Prevention (CDC) recommends specific regimens for chlamydia and dual therapy for gonorrhea to mitigate antimicrobial-resistant gonorrhea in the CDC 2015 sexually transmitted disease treatment guidelines. Only limited studies examining adherence to these recommendations have been conducted at private practices in the United States. We used the OptumLabs Data Warehouse, a comprehensive, longitudinal data asset with deidentified persons with linked commercial insurance claims and clinical information, to identify persons aged 15 to 60 years who had valid nucleic acid amplification testing results demonstrating urogenital or extragenital gonorrhea or chlamydia in 2016 to 2018. We defined valid laboratory results as positive or negative. We then assessed the time of their first positive test result and the type of treatment within 30 days to determine if there was evidence in the claims record that the CDC-recommended treatment was provided. We defined presumed treatment if the date of treatment was before the date of the positive test result within 30 days. Among 6476 patients with positive gonorrhea test results and 26,847 patients with positive chlamydia test results only, 34.8% and 64.2% had evidence of receiving the CDC-recommended therapy, respectively. Approximately 11.6% of patients with positive gonorrhea test results with recommended dual treatment and 7.1% of patients with positive chlamydia test results only with recommended chlamydia treatment were presumptively treated. Analysis of treatment claims and medical records from private settings indicated low rates of recommended gonorrhea and chlamydia treatment. Validation of treatment claims is needed to support further quality of care interventions based on these data.

High in vitro activity of DIS-73285, a novel antimicrobial with a new mechanism of action, against MDR and XDR Neisseria gonorrhoeae.

BackgroundThe rising incidence of antimicrobial resistance in Neisseria gonorrhoeae may result in untreatable gonorrhoea in certain circumstances and development of novel antimicrobials is urgently needed.ObjectivesTo evaluate the in vitro activity of a novel small-molecule antimicrobial with a new mechanism of action, DIS-73285, against a large geographically, temporally and genetically diverse collection of clinical N. gonorrhoeae isolates and reference strains, including various types of high-level resistant, MDR and XDR gonococcal isolates (n = 262).MethodsMICs (mg/L) of DIS-73285 were determined by agar dilution and by Etest for ceftriaxone, cefixime, azithromycin, ciprofloxacin, ampicillin, spectinomycin and tetracycline.ResultsDIS-73285 was substantially more potent than any of the currently or previously used therapeutic antimicrobials, with MICs ranging from ≤0.001 to 0.004 mg/L, and the MIC50, MIC90 and modal MIC all ≤0.001 mg/L (lowest MIC tested). No correlation with the MICs of DIS-73285 and the MICs of any of the currently or previously used antimicrobials was observed.ConclusionsThe novel chemotype, small-molecule antimicrobial DIS-73285, demonstrated high in vitro potency against all tested N. gonorrhoeae isolates. Further in vitro and in vivo studies, evaluating efficacy, resistance emergence, pharmacokinetic/pharmacodynamic parameters, toxicity and safety, should be conducted to evaluate DIS-73285 as a therapy specifically for urogenital and extra-genital gonorrhoea.

Extragenital Screening for Chlamydia and Gonorrhea Among Adolescents and Young Adults at a Sexual Health Clinic

ObjectiveTo increase screening rates for oropharyngeal and rectal (extragenital) chlamydia and gonorrhea infections among adolescents and young adults by 20% and for 90% of nurses to demonstrate a change in behavior and knowledge surrounding extragenital screening. DesignA pre- and posttest design to evaluate nurse knowledge and the percentage of extragenital chlamydia and gonorrhea screenings completed before and after a 2-month intervention period. SettingReproductive health clinic for adolescents and young adults up to age 25 years in the Twin Cities metropolitan area of Minnesota. ParticipantsFour registered nurses who provide direct client care at the identified sexual and reproductive health clinic. Intervention/MeasurementsWe implemented an education session for four staff nurses, a standardized sexual history taking tool, and protocols for obtaining oropharyngeal and rectal specimens. We measured extragenital chlamydia and gonorrhea screening rates, as well as knowledge and behavior change among registered nurses. ResultsData came from records for 623 individuals who were deemed at risk for extragenital chlamydia and gonorrhea infection. Extragenital chlamydia and gonorrhea screening rates increased by more than 700% from before to after the intervention. Five out of nine (55.6%) extragenital chlamydia and gonorrhea infections diagnosed would have been missed with urogenital screening alone. One hundred percent of nurses demonstrated an increase in their knowledge of the 5 P’s of sexual health (Partners, Practices, Protection from sexually transmitted infections, Past history of STIs, and Prevention of pregnancy) to conduct a risk assessment, the eligibility criteria for extragenital testing, and the actual collection processes of pharyngeal and rectal swabs. ConclusionUse of evidence-based recommendations and a collaborative team facilitated a more consistent approach to the assessment and diagnosis of extragenital chlamydia and gonorrhea infections. Generalizability is limited to the project site; however, this process could be implemented in other clinics to determine if similar results can be achieved.

The Use of Gentamicin for Treatment of Urogenital and Extragenital Gonorrhea: A Systematic Review of Efficacy Data

To evaluate clinical efficacy data for gentamicin in the treatment of gonorrhea. A keyword search of PubMed (1966 to April 2020), EMBASE (1947 to April 2020), and International Pharmaceutical Abstracts (1970 to April 2020) was conducted. The electronic search was supplemented with manual screening of references from identified articles and a search of ClinicalTrials.gov to identify ongoing trials. Comparator and noncomparator studies reporting microbiological outcomes of treatment with gentamicin for gonorrhea in humans were included. Data extracted included study year, authors, aim, setting, population, dosing protocols, and outcome results. Risk of bias was assessed according to the Cochrane Risk of Bias Assessment Tool. A total of 407 articles were identified, of which 11 met inclusion criteria. Two studies were randomized controlled trials, and 1 additional randomized noncomparator study was identified. All other studies were nonrandomized and noncomparator in nature. The highest quality evidence suggests that gentamicin is not noninferior to ceftriaxone (both in addition to azithromycin) for treatment of gonorrhea but may achieve cure rates >90%. Conflicting evidence exists regarding the efficacy of gentamicin-based regimens for the specific treatment of extragenital gonorrhea. Results of this review could affect patient care and clinical practice because they clearly demonstrate the role of gentamicin for the treatment of gonorrhea as a second-line agent. Future research should confirm findings, especially for the role of gentamicin in extragenital infections. Gentamicin-based regimens should be reserved for second-line treatment of urogenital and extragenital gonorrhea infections.